Co-production in social care: What it is and how to do it

How to do co-production - Structure

Thinking about structure involves considering how an organisation or initiative is arranged. This includes looking at decision-making structures, leadership and the way the organisation plans and develops projects.

An evaluation of six peer support work pilot projects found that the development of peer support had been held back by the lack of infrastructure and clear role descriptions. Also, integrating peer support workers within existing teams was a challenge. [17*]

So it is very important to change the role, systems and structures of an organisation so that it can support co-production. [14] Examples of the types of structural changes that might be required are:

new goals

revisions to staff roles

developing peer/mutual support networks

new management structures

revised procedures for commissioning.

This may be particularly challenging for large organisations as co-production puts an emphasis on personal relationships. Organisations will need to move away from centralised and hierarchical structures so that they can support co-production. [14]

There is a need for more evidence about the structural changes that organisations need to make to achieve transformative co-production. [14]

Building on existing structures and resources

Developing a co-productive approach does not necessarily mean starting from scratch. There may be an opportunity to build on existing cultures, structures and practices. [17*]

The most successful co-production may come from building on the resources already in the community: ‘Clearly, the most effective and efficient forms of community co-production tap into existing social networks.’ Outreach work in the community is a way of identifying and building links with the community. [10]

Practice examplesOpen

Action for Carers Surrey

The group of organisations in the coalition used the existing joint planning structure of the county council and the primary care trust to co-produce its new service. It was able to build on a structure that had a history of working well in the county and had developed a culture of close cooperation between all parties.

The Healthy Living Club

This club has really benefited from the structures available in the local community. A staff member from the local Age UK gave practical support and agreed to be a part of the management committee.

Good contacts have also been developed with the local time bank so that the volunteers at the club can earn credits for their volunteering activities. They can use the credits to buy local goods and services through the ‘local currency’ – the Brixton Pound.

All Together Now

This project began by using a community development approach called ‘Learning, Evaluation and Planning (LEAP)’. This focuses on outcomes and learning together. It began by identifying the groups and agencies in the community working with older people. It then supported them to get to know what each other does and how they can work together.

KeyRing

This organisation recognises the importance of networking with all sections of the community. This includes working with people in local authorities – ranging from housing officers to librarians. It also involves bringing in members of the community as volunteers when needed.

Identifying and involving the right people from the start

It is important to identify all the people who need to be involved in any co-production project or initiative at the beginning of the process. [20]

Practice exampleOpen

Birmingham City Council’s Adults and Communities Directorate

This directorate organises an annual opportunities fair for disabled people. After the first fair, volunteers involved in organising the event asked to be involved all the way through the planning process for the following year. This meant that they were part of the decision-making process and made choices about the venue, the structure of the fair, marketing and deciding on people’s roles.

Resources for co-production

The costs of doing co-production and getting people on board are an important issue to think about. As a new process, co-production is time-consuming and will need resources for building the project and for support. [12] If there is a reluctance to commit resources, this may affect how the project progresses and what it is able to achieve. [12, 56*]

In rural areas, the costs of co-production will be particularly high because people will be coming to the project from a wide geographical area and they may need to travel some distance. [23] It is recommended that people’s expenses – like train tickets and hotels – are paid where possible. [22]

Practice examplesOpen

The Healthy Living Club

This club faced closure when its original funding was withdrawn but continued because of the efforts of its members, their carers and volunteers. The club’s coordinator agreed to work unpaid until more funding was secured.

Funding has now been secured for the club and for the coordinator to be paid, but it is still essential that the club keeps generating income if it is to survive in the long term. Some members use their personal budgets to pay for support they get from the club.

Action for Carers Surrey

Funding from the National Carers’ Strategy meant that this coalition was able to pioneer a system of direct payments for respite care. Local funding will continue until 2014. It is hoped that clinical commissioning groups (the new structure for general practitioners to buy services for their patients) will continue the funding when they see the evidence of the value of the service.

Birmingham City Council’s Adults and Communities Directorate

The directorate saw a clear need for resources to support co-production in terms of an allocated budget and dedicated staff time.

Redesigning Support for Care Leavers

This project was funded with resources from the three agencies involved. This paid for the costs of an independent facilitator and for the costs and expenses of the young people who took part in the project.

Structures for valuing and rewarding people

The issue of paying people emerged as a key concern in the practice examples and in the discussions at the Project Advisory Group. Some of the practice examples saw this as one of the most difficult issues that they experienced in the co-production process.

It has been recognised for a long time that payments to people who use services and carers for taking part in activities such as co-production are a problematic matter. This is mainly because of the impact of rules and regulations around welfare benefits. [58] SCIE has produced a guide to the most recent changes to these rules. [59]

There are growing constraints on financial resources and some organisations may find it difficult to pay fees. They may only be able to use other ways of rewarding people.

Time banks are used more and more as a way of rewarding people who take part in co-production. The simple principle behind them is that one hour of everyone’s time should be valued in the same way. They are a way for people to exchange skills and services. They have been described as providing a way of valuing and measuring the work done by people and communities that is not paid. [25]

Time banks have been described as showing some of the core values of co-production. [59] They recognise people’s assets, support equality and they include reciprocity (where people get something back for having done something for others). The benefits of time banks are as follows:

they help more people to get involved in providing services

they help communities to do more with less resources

they support social justice by rewarding everybody equally

they make communities stronger by building links and networks between people. [60]

There is a growing number of successful time banking schemes in the United Kingdom and abroad. Two examples of time banks are:

CareBank. This scheme is based in the borough of Windsor and Maidenhead. People who give support to older people and other people who use services in the area – by doing things such as shopping, housework and getting them out of the house – are rewarded with credits to use at local authority facilities.

Glynoch Youth Time Bank (part of Time for Young People) in South Wales. This has supported young people to produce a mural at a primary school, run a youth club and help run a community centre. In return, the young people have been able to use time bank credits for activities ranging from going to the theatre to quad biking.

Timebanking UK has a practical online guide to setting up and being a member of a time bank.

Practice examplesOpen

Look Ahead Care and Support

Look Ahead wanted to recognise and reward customers for their contribution. It developed a recognition and reward policy to address this. It offered people who use their services the chance to earn credits that could be spent in the local community. This was arranged through linking up with a local time banking organisation.

Redesigning Support for Care Leavers

One of the problems that this project came across was the inequity of young people not being paid for their time when everyone else taking part was being paid. This was seen as an important ethical dilemma. The organisations involved weren’t able to resolve this issue during the project. But they will consider it for future work. And one of the organisations has developed a policy to pay people who use services.

Rewarding people for getting involved in co-production activities is clearly important. But there is also a need to recognise the other benefits that people who use services and carers can gain from the experience of co-production. This is an area where there is strong evidence. For example, being part of an organisation that is led by people who use services is a positive experience. It contributes to a sense of shared identity and purpose. And it also improves the outcomes of a project. [41*]

In the mental health field, peer support workers report benefits around the building of confidence and self-esteem. [61*] They also say that co-production has helped them in their personal recovery from mental health problems. [61*, 62*] And it can improve peer support workers’ chances of further employment too. After one peer support training programme, three-quarters of the people who attended went on to take part in or set up mutual support groups. [63*] ‘Gone from how we were unemployable because we’re mentally ill, to mentally ill, therefore, we’re employable.’ [62*]

People may get similar benefits from other co-production activities. If people who use services and carers understand the benefits of co-production this is likely to encourage them to take part. This maybe especially helpful in projects where it is not possible to offer direct financial rewards.

The Project Advisory Group noted that professionals also gain from the experience of being involved in co-production. Professionals often say that working in a co-productive way is more satisfying and rewarding.

Practice examplesOpen

KeyRing

KeyRing believes that co-production gives people a sense of self-worth and helps them to become more confident. Some KeyRing members have found that their increased self-esteem has helped them to get paid work.

Birmingham City Council’s Adults and Communities Directorate

People who have been involved in this project have grown in confidence and self-esteem. They say that they are now ready to take on new challenges. They have shared the rewards of a job well done.

Structures for communication

The Culture subsection noted how important it is to use language that is accessible and understandable for everyone involved.

Accessible communication needs to be supported by strategies that are flexible and use a range of different approaches to communication. This will ensure that people have as much opportunity to take part as possible. These approaches should include meetings, telephone conversations and online interaction. [64]

The main evidence about the importance of communication comes from the practice examples, detailed below. This is an area where more evidence is needed. The importance of relationships in co-production suggests that personal contacts and ‘word of mouth’ (people telling other people about something) may have a particularly important role in the co-production process.

Practice exampleOpen

Birmingham City Council’s Adults and Communities Directorate

The directorate makes sure that it has good communication with people who use its services. It does this by finding out each person’s preferred way of communicating. This means that communication takes place using accessible formats. Examples include easy read documents, large print documents, sending printed documents where these are needed and using email if people use computers/the internet.

The directorate has also used a range of methods to promote co-production activities to the widest audience possible in the city. This has included using a range of media – radio, posters, flyers, the local paper and the council’s website – and ‘word of mouth’.

Social media may have a lot of potential for supporting co-production. For example, it can help to overcome the barriers that people face in accessing information and services. It can also provide new ways of influencing public awareness and policy. [18] And Facebook has been used to start some community projects. [65] But there needs to be a focus on the media that most people are likely to use. While social media has become a popular way for councils to communicate with people, email and text messaging are better ways to reach many people. When organisations and projects think about how they are going to communicate with people, they need to make sure they take a balanced approach. [66]

Practice examplesOpen

Redesigning Support for Care Leavers

This project found that it was more helpful to use models to show ideas rather than just verbally describing them. This included producing maps and writing ‘mock’ information packs to show what proposed services would actually look like. This helped them check that everyone had the same understanding of what was being suggested and explore whether it would work. Regular blogs were published on the project’s website with details of the project’s work.

The Healthy Living Club

This club used social media to raise awareness of its facilities. It also found social media useful for fundraising.

Recommendations

Involve everyone who will be taking part in the co-production from the start.

Value and reward people who take part in the co-production process.

Ensure that there are resources to cover the cost of co-production activities.

Ensure that co-production is supported by a strategy that describes how things are going to be communicated.

Build on existing structures and resources.

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